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Endometriosis: Clinical Manifestation and Differential Diagnosis
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Pelvic Congestion Syndrome is frustratingly a difficult diagnosis due to controversial diagnostic methods and poor understanding of its etiology, and there are no specific diagnostic criteria. The symptoms of this condition can greatly overlap with many pelvic conditions, and the syndrome can be seen more in multiparous and overweight women, as well as present secondary to vascular anomalies and previous pelvic thrombotic events (55). Attention to the presence of varicosities and hemorrhoids can be a clue as well as worsening of premenstrual symptoms, after long standing, fatigue and after intercourse. Ultrasound assessment will show the diameter of the uterine vessels more than 8 mm, and Doppler studies will observe slow blood flow, reversed direction and the communicating pattern of the arcuate veins (64).
Urinary System
Published in Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard, Toxicologic Pathology, 2018
Kendall S. Frazier, John Curtis Seely
The renal vascular supply arises from the renal artery, which branches into the interlobar arteries. The interlobar arteries continue as arcuate arteries that run parallel to the capsule along the corticomedullary junction. These continue as interlobular arteries and eventually to afferent arterioles and glomerular capillaries. Efferent arterioles that arise from glomeruli near the medulla give rise to interconnecting vasa recta which supply the medulla. These vessels eventually coalesce to form arcuate veins. The distal straight (S3) segment of the proximal tubule and focal areas of the medullary thick ascending limb of the loop of Henle are the most susceptible regions of the nephron to ischemic injury (Venkatachalam et al. 1978), but this has more to do with the metabolic oxygen demand and Na+ K+ ATPase activity of these tissues than their architectural arrangement or vascular supply. Cortical short loop nephrons show more extensive damage with ischemia than the long-looped juxtamedullary nephrons. While the cortex receives the vast majority of RBF (>90%) as compared to medulla (resulting in higher vascular concentrations of drug), the medullary ducts are potentially exposed to higher concentrations of drug or metabolites in the urinary solute over time. The major lymphatic drainage follows the vasculature in all species, but an additional capsular lymphatic system has been described in humans and monkeys (Osathanondh et al. 1966).
Management of pelvic congestion syndrome and perineal varicosities
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
Sonographic findings suggestive of PCS include ovarian vein dilation >4 mm with sluggish (<3 cm/second) or retrograde (craniocaudad) flow, dilated and tortuous pelvic veins >6 mm in diameter, and dilated arcuate veins within the myometrial or pampiniform plexuses that communicate with the iliac venous system.19–21 Interestingly, an association of PCS with polycystic ovary disease has been consistently observed.20
Comprehensive overview of the venous disorder known as pelvic congestion syndrome
Published in Annals of Medicine, 2022
Kamil Bałabuszek, Michał Toborek, Radosław Pietura
Ultrasound (US) remains the first line, screening imaging study. Conventional B-mode assesses pelvic anatomy and excludes masses, while color-Doppler measures flow. Ultrasound has the advantage of allowing dynamic examination with provocative Valsalva manoeuvres [60,61]. The ultrasound can be either transvaginal, transabdominal or transperineal [62]. Transvaginal ultrasound (TVU) may better rule out other gynecological problems, but transabdominal and transperineal US allows to visualise the vessel on a longer course [62,63]. Findings suggesting the diagnosis are tortuous pelvic veins with a diameter more than 4 mm, slow (≤ 3 cm/s) blood flow and dilated arcuate veins in the myometrium, communicating with the pelvic varicosities [63]. According to Park et al. positive predictive value as a cut-off diameter of a left ovarian vein in the US was 71.2% at 5 mm, 83.3% at 6 mm, 81.8% at 7 mm, and 75.8% at 8 mm [64].